[Risk factors for and prognostic value of multifocal atherosclerosis in patients with diabetes mellitus].

AIM: To study the prognostic value of multifocal atherosclerosis (MFA) in patients with diabetes mellitus (DM) at high risk for myocardial ischemia who need coronary angiography (CAG). SUBJECTS AND METHODS: The investigation included 148 patients: 25 with type 1 DM (DM1), 73 with type 2 DM (DM2), and 50 without DM who had undergone CAG. Duplex ultrasound scanning of lower limb vessels and brachiocephalic and renal arteries was carried out in all the patients. RESULTS: Involvement of two or more vascular beds was noted in 60% of the patients with DM1, in 68.4% of those with DM2, and in 34% of those without DM (p < 0.05). Regression analysis showed that the risk factors of MFA were defined to be myocardial infarction (MI) in the history (OR=2.4; p=0.02), DM (OR=3.9; p=0.0002), smoking (OR=2.4; p=0.05), elevated creatinine (OR=6.5; p=0.002) and fibrinogen (OR=6.8, p=0.004) levels. Among the DM patients, there were 26.5% of those who had achieved a main assessment criterion (a combined end point (CEP)), such as death, urgent hospitalization for heart failure, nonfatal MI, nonfatal stroke, lower extremity amputation, double creatinine levels, and achievement of end-stage renal failure during a 24-month follow-up. In patients without carbohydrate metabolic disturbances, this indicator was 12% (p=0.01). During the prospective study, a total of 6.1% of patients died in the DM group; all the patients in the non-DM group completed the study. Calculation of survival rates by the Kaplan-Meier method indicated that the DM patients with concurrent atherosclerotic lesion had achieved CEP significantly more frequently than the comparison group. Such differences were absent among the persons without carbohydrate metabolic disturbances. CONCLUSION: The regression analysis has shown that prior MI, DM, smoking, creatinine and fibrinogen levels are factors associated with the development of MFA in the examined groups. In the patients with DM, concurrent atherosclerosis of two or more vascular beds is an important factor for the progression of cardiovascular and renal diseases.

[The characteristics of hemodynamics and regulation of heart rhythm at different post-stroke stages]. / Osobennosti gemodinamiki i reguliatsii serdechnogo ritma v raznye periody ishemicheskogo insul'ta.

Objective. To investigate the characteristics of hemodynamics and regulation of heart rhythm after ischemic stroke. Material and methods. We used a rat photochemical model of ischemic stroke. Results. In the subacute stage of stroke, different hemodynamic disturbances in rats with high and low levels of heart's functional capacity (HFC) were found, with more severe disturbances in animals with low HFC. Conclusion. Though the disturbances in the autonomic heart regulation, related to HFC, did not emerge in the early post-stroke stage, HFC predicted the trajectory of post-stroke recovery.

[Prevalence and risk factors of extra-coronary artery disease in patients with diabetes which confirmed atherosclerosis of coronary arteries].

AIM: To assess prevalence and risk factors of extra-coronary artery disease (peripheral artery (PA) disease (D) of lower extremities (LE), brachiocephalic arterial (BCA) stenosis (S), renal arterial (RA) S in type 1 and 2 (T1 and T2) diabetes (D) patients (P) with confirmed atherosclerosis of coronary arteries (CA). MATERIAL: 100 P (48 with T2D, 18 with T1D, 34 without diabetes - PWD), with hemodynamically significant atherosclerosis of CA confirmed by coronary angiography. METHODS: All patients underwent duplex ultrasonography of PA LE, BCA, RA. Other studies included assessment of clinical characteristics and measurement of the following parameters: profibrogenic cytokines (transforming growth factor [TGF] beta1, matrix metalloproteinase 9 [MMP9], monocyte chemotactic protein-1 [MCP-1], regulated on activation normal T-cell expressed and secreted [RANTES), markers of endothelial dysfunction (von Willebrand factor [VWF], homocystein [HCYST], plasminogen activator inhibitor-1 [PAI-1], vascular cell adhesion molecule [VCAM], soluble intercellular adhesion molecules-1 [sICAM], vascular endothelial growth factor [VEGF], asymmetric dimethylarginine [ADMAD, N-terminal fragment of pro-brain natriuretic peptide (NT-pro BNP), fibroblast growth factor 23 (FGF-23), and fibrinogen. RESULTS: Portions of P with multivessel CA disease were similar in all three groups (T1D - 88.9, T2D - 85.5, WD - 82.3%). Coexistence of atherosclerosis in 2 or more vascular beds was identified in 85.3% of T2D and in 50% of WD P (p = 0.005). In T1D group 61.1 and 11.1% of P had atherosclerosis in 2 and 3 vascular beds, respectively. Levels of profibrogenic cytokines and factors of endothelial activation (RANTES, MMP-9, PAI-I, VCAM, sICAM, ADMA) were significantly higher in P with diabetes vs P WD. P with diabetes and multifocal atherosclerosis demonstrated significant increases of CRP, fibrinogen, NT-proBNP, VWF, PAI-1, ADMA, sICAM, and decrease of GFR compared with P with atherosclerosis in 1 vascular bed. Logistic regression model identified diabetes, reduced renal function, previous myocardial infarction, smoking, ADMA and fibrinogen as factors associated with presence of multifocal atherosclerosis. CONCLUSION: Coexistence of atherosclerosis in two or more vascular beds was more frequent in P with diabetes and hemodynamically significant CA atherosclerosis than in PWD. It was associated with renal and cardiac dysfunction, excessive activation of mediators of inflammation, hemostasis, and factors of endothelial damage.

[Prognostic factors for progression of mitral regurgitation in patients with coronary heart disease after aortocoronary bypass surgery alone and in combination with surgical left ventricular reconstruction].

AIM: To identify risk and prognostic factors for mitral regurgitation (MR) progression after aortocoronary bypass surgery (ACBS) alone and in combination with surgical left ventricular (LV) reconstruction. SUBJECTS AND METHODS: Data on 101 patients with coronary heart disease who had undergone surgical treatment: ACBS alone in 57 (56%) patients and that in combination with surgical LV reconstruction in 44 (44%). RESULTS: In the late periods after ACBS alone, there was reduced or no MR in 18% of the patients; no substantial changes in MR in 52%, the latter being moderate; progression to significant mitral insufficiency (MI) in 30%. In the same periods after ACBS in combination with surgical LV reconstruction, there was a reduction in MR to its minimum or complete absence in 14% of the patients; no substantial change in the degree of MR in 54%, and progression to significant MI in 32%. The prognostic factors of MI progression after ACBs alone and in combination with surgical LV reconstruction were a more than 32-mm fibrous ring of the mitral valve (MV) (chi2 = 11.62; p = 0.0001); a LV sphericity index of more than 0.65 cm (chi2 = 3.38; p = 0.06); a myocardial scar lesion extent of more than 30% of the LV segments (chi2 = 4.7; p = 0.03); a myocardial reserve of less than 25% (chi2 = 3.1; p = 0.07) (when taking low-dose dobutamine). CONCLUSION: Myocardial revascularization should be combined with MV intervention in patients with moderate MR and risk factors for its progression, such as significant LV remodeling (LV sphericity index of more than 0.65 cm), extensive LV scar lesion (more than 30% of the segments), a low myocardial reserve (less than 25%) during dobutamine test, and a MV fibrous ring of more than 32 mm).

[Prehospital management of patients with acute coronary syndrome in Moscow. Data of the first Moscow "snapshot" register].

AIM: To characterize the state of prehospital management of patients with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized patients with ACS. METHODS: The registry included data on consecutive patients with ACS admitted to coronary care units or their equivalents of participating hospitals within 24 hours after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 PCI capable or "invasive") city hospitals officially treating ACS patients. Data concerning prehospital stage was collected by hospital physicians. RESULTS: Among 584 patients included in the registry 88.8% were brought by ambulances. Time (median) from onset of symptoms to call for medical aid was 2.4 h, to hospitalization - 4.3 h, from call for medical aid to hospitalization--1.6 h. Calculated approximate time of contact of ambulance staff with patient at site of attack (the latter time minus official time to arrival and transportation time) was more than 50 min. Referral diagnoses were myocardial infarction (MI) in 29.3, unstable angina in 48.4, other acute conditions in 22.3% of patients. Among patients referred as unstable angina about 49% were diagnosed as MI during hospitalization. Referral diagnosis of ambulance physicians did not appear among independent predictors of inhospital death or new MI (ST depressions, Killip class > or = ll, high GRACE score). Rate of prehospital thrombolysis was 8.0% among all patients diagnosed in hospital as ST elevation (STE) ACS (10.8% among STEACS patients admitted within 12 h of symptoms). There were significantly less patients older than 65 years among those subjected compared with not subjected to prehospital thrombolysis (23.1% vs. 59.6%, respectively; p = 0.024). Clopidogrel (mostly 300 mg) and recommended loading dose of aspirin were given to 70.9 and 51% of patients, respectively. Unfractionated heparin and enoxaparin were given to 49.4 and 7.5% of all patients, respectively. Inhospital bleeding rate was significantly higher in patients phehospitally treated with anticoagulants. CONCLUSION: The following characteristics of prehospital management of patients diagnosed as ACS at hospital (CCU) admission could be object of improvement: long time of contact of ambulance staff with patients; attempts to diagnose (exclude) MI associated with unjustified referral to noninvasive hospitals; preferential use of thrombolysis in younger patients; relatively rare use of guideline recommended doses of aspirin and clopidogrel. Of note is association of inhospital bleedings with prehospital administration of anticoagulants.

[First Moscow "snapshot" register of acute coronary syndromes: characteristics of patients, management and outcomes during hospitalization].

AIM: To characterize inhospital management of patients (pts) with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized pts with ACS. METHODS: The registry included data on consecutive pts with ACS hospitalized with label ACS in coronary care units (CCU) or equivalents within 24 hours (h) after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 percutaneous coronary intervention [PCI] capable or "invasive") city hospitals officially treating ACS patients. RESULTS: Total number of pts--584 (mean age 66.4 +/- 13.1 years; > or = 65 years 54.6%; women 44.2%; registered in invasive hospital--42%). Portions of pts labeled ST-elevation (STE) and non ST-elevation (NSTE) ACS--27.9 and 72.1%, respectively. Portion of pts hospitalized within 1-st 12 h after symptoms onset--65.2% (68% among STEACS pts). Reperfusion therapy--44.8% of pts with STEACS (54.3% in invasive and 21.3% in noninvasive hospitals, p < 0.0001). Thrombolysis (TI) was performed in 19% of STEACS pts (41.9% prehospital). In hospital median admission to initiation of TI time--0.30 h (quartiles I-III 0.15-0.30 h). Rate of primary (p) PCI in STEACS pts--overall 25.8%, in invasive hospitals--36.2%, in pts admitted within 12 h--31.4 and 40.5%, respectively. Median admission--pPCI initiation time--1.35 h (quartiles I-III 1.00- 2.15 h). PCI rate among NSTEACS pts--6.2 overall and 20.5% in invasive hospitals (14.7% during 1st 72 h). Medication in hospital: aspirin--95.2, clopidogrel--70.7, ticagrelor--4.3%, parenteral anticoagulants--88.9 (1/3 unfractionated heparin [UFH] subcutaneously), ACE inhibitors--83.3, beta-blockers--86.3, statins--58.3%. Mean duration of hospital stay--13.2 +/- 4.4 days. Transferral from noninvasive to invasive hospital for urgent coronary intervention--4.5 and 3.5% of STE and NSTE ACS pts, respectively. Hospital mortality--12.4 and 1.9% among pts registered as STE and NSTEACS, respectively. Cardiac troponins measured--42% (39% among STEACS) pts. CONCLUSION: The following features of inhospital management of pts diagnosed as ACS at CCU (or its equivalent) admission could be object of improvement: low rate of reperfusion therapy and use of PCI, long interval between admission and initiation of PCI, insufficient use of some standard medications, frequent use of subcutaneous UFH, rare transferal of PCI eligible pts from noninvasive to invasive hospitals. However existing management was associated with reported low hospital mortality in patients labeled as NSTEACS.

[Aspects of risk stratification in acute coronary syndrome: prognostic value of evaluation of left ventricular myocardial viability according to the data of pharmacological stress echocardiography].

AIM: To define the prognostic value of the indicators of left ventricular myocardial viability according to the data of pharmacological stress echocardiography in patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: The results of examinations were analyzed in a total of 91 patients with ACS; 71 of them were found to have areas of asynergy (these cases formed the key basis for statistical processing). An analysis of the outcomes registered in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA)). RESULTS: Risk stratification for cardiac events in patients with ACS requires both the assessment of a myocardial viability testing result and the detection of stress-induced ischemia. An analysis of the impact of the indicators of myocardial viability on prognosis in the ACS group showed that the most important predictors of cardiac death were impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at rest; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; TEF, deltaTEF (as compared to the baseline data), and a positive or negative peak stress testing result. The most important predictors of major cardiac events (death MI, UA) were ascertained to be ISCI, number of asynergic segments, resting TEF; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; a positive or negative testing result, TEF, deltaTEF (as compared to the baseline data), and ISCI during the peak stress test. CONCLUSION: The low myocardial/coronary reserve increases mortality rates; the high one worsens the prognosis of major cardiac events, particularly when the test is positive, which tacitly transfers these patients to a very high risk group.

[Aspects of risk stratification in acute coronary syndrome (Part II): Prognostic value of evaluation of exercise-induced myocardial ischemia according to the data of pharmacological stress echocardiography].

AIM: To define the prognostic value of evaluation exercise-induced myocardial ischemia according to the data of pharmacological (dobutamine or dipyridamole) stress echocardiography (EchoCG) in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: The results of examinations were analyzed in a total of 91 patients with ACS. An analysis of events in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration outcomes, such as death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA). RESULTS: Pharmacological stress EchoCG showed a positive result in 40 (44%) patients (Group 1) and a negative one in 51 (56%) patients (Group 2). Thus, the sensitivity and specificity of the pharmacological test in determining the risk for cardiac events were 89.3 and 76.2%, respectively; the prognostic value of positive and negative results was 62.5 and 94.1%, respectively. Analysis of EchoCG parameters used to identify poor prognostic factors in patients with ACS has indicated that the most important predictors of death and major cardiac events (cardiac death, acute MI, UA) are resting impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at baseline; TEF, ISCI, deltaISCI (as compared to the baseline data), and the number of segments with a negative response after low-dose drug infusion; a positive or negative result, TEF, deltaTEF (as compared to the baseline data), and ISCL at the test peak. CONCLUSION: Pharmacological stress EchoCG is a safe noninvasive diagnostic method in a group of patients with ACS. When the latter is diagnosed, it may be performed in the earliest periods (on day 4 after onset of the disease) to estimate its prognosis and to decide whether aggressive treatments should be used.

[Renal artery stenosis in patients with type 2 diabetes mellitus: clinical signs, diagnosis, prognostic value].

AIM: To define the prevalence, clinical features, risk factors, and prognostic value of atherosclerotic renal artery stenosis (RAS) in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: One hundred and fifty-seven T2DM patients (63 males and 94 females) aged over 50 years were examined. Screening for RAS was carried out by duplex ultrasound scanning (DUSS); the diagnosis was verified by multispiral computed tomography and magnetic resonance imaging. Moreover, the detection rate of RAS was analyzed from the selective angiographic readings of 30 patients with T2DM and 26 coronary angiography patients without DM who had undergone coronary angiography (CA). RESULTS: In the total group of T2DM patients, the RAS detection rate was 36.9%, as evidenced by DUSS and 43.3% by selective renal artery angiography in the patients who had undergone CA. The factors associated with the development of RAS were smoking (relative risk (RR) = 3.3; p < 0.001); atherosclerosis of coronary (RR = 4.28; p < 0.001) and peripheral (RR = 3.38; p < 0.02) arteries, isolated systolic hypertension (RR = 3.9; p < 0.01), and anemia (RR = 6.4; p < 0.001). In patients with T2DM, RAS was one of the important factors of progressive renal and cardiac diseases and increased mortality determined by the combined end point: death, emergency hospitalization for heart failure, myocardial infarction, double creatinine, and end-stage renal failure (RR = 6.28; p < 0.001). CONCLUSION: The optimization of prognosis in T2DM patients with RAS requires its timely clinical identification in combination with other types of renal lesion, aggressive correction of the mechanisms of the progressive process, and development of medical and endovascular therapies.

[Contrast-induced nephropathy in coronarography of patients with type 2 diabetes mellitus: risk factors, prognostic significance, prophylactic approaches].

AIM: To determine risk factors, prognostic implications and prophylaxis of contrast-inducible nephropathy (CIN) during coronarography (CG) in patients with type 2 diabetes mellitus (DM). MATERIAL AND METHODS: Records for 151 patients with type 2 DM and 50 non-diabetic patients examined with CG in A.N. Bakulev Research Center for Cardiovascular Surgery in 2000-2007 were analysed retrospectively. All the patients have undergone clinical examination including tests for blood serum creatinine before and after 48 hours after CG, standard ECG and echocardiography. Glomerular filtration rate was estimated by MDRD formula. Selective CG was made with application of contrast agent Omnipak-300 (iohexol). RESULTS: CIN after CG more frequently developed in diabetics than in non-diabetic patients matched for age, renal function, dose of contrast medium and hydration regime (40.4 and 16%, respectively; p < 0.002). Risk of CIN in patients with type 2 DM was associated with cardiac failure of NYHA class III-IV, anemia, dose of the contrast agent, intake of diuretic drugs before and after the procedure, multiple affection of the coronary vessels, necessity of intervention. Patients with type 2 DM and CIN showed more rapid decline of the renal function, more frequently developed severe cardiovascular events, had worse 1-year survival. CONCLUSION: High probability of CIN and its prognostic significance in type 2 DM patients necessitates assessment of an individual risk for taking preventive measures during conduction of contrast diagnostic procedures.

[Disturbances of thyroid function after coronary angiography].

Frequency of thyroid gland functional disturbances after introduction of iodine-containing radiographic contrast agents during coronary angiography was studied in 146 patients, residents of the zone of borderline iodine deficit. Frequency of thyroid pathology was high at baseline (39%). Functional state of the thyroid gland was assessed before and 1, 3, 6, 12 months after investigation. During first month after coronary angiography there were several new cases of thyrotoxicosis and hypothyroidism, as well as deterioration of preexisting functional disturbances of the thyroid. Patients with baseline pathology and functional disturbances of thyroid gland before conduction of coronary angiography should be included into risk group of development of iodine induced states.

[Immediate and remote results of stenting of left coronary artery trunk in patients with ischemic heart disease].

The aim of this investigation was assessment of efficacy of stenting in patients with ischemic heart disease with lesions of left coronary artery (LCA) trunk. In the A.N. Bakulev Scientific Center of Cardiovascular Surgery between June 1997 and March 2005 stenting of LCA trunk was carried out in 50 patients (33 with stable effort angina and 17 with acute coronary syndrome). Immediate success rate was 100% in patients with stable angina. In a group of patients with acute coronary syndrome angiographic success rate was 100%. Total lethality in this group was (3 cases) 17.7%. In remote period (6 to 60 months) 33 of 39 patients were examined and recurrence of angina was noted in 7 of them (21.1%). Control angiography was carried out in 16 patients and restenosis of LCA was revealed in 18.75% of cases. The authors believe that stenting of LCA trunk is an effective and safe method of treatment of patients with stable angina and sufficiently safe method in patients with acute coronary syndrome. Roentgenoendovascular treatment may serve as an alternative to aortocoronary bypass surgery especially in isolated lesions of LCA trunk. Application of stents with drug coating allows to cardinally improve long term results of stenting.

[Interrelationship between functional state of the right ventricle and severity of heart failure in patients with ischemic heart disease and depressed left ventricular function].

Dobutamine Doppler echocardiography was carried out in 56 patients (n=56) with ischemic heart disease and depressed left ventricular function (left ventricular ejection fraction <40%) and chronic heart failure. Clinical signs of heart failure were moderate (NYHA class I-II) in 34 and severe (NYHA class III-IV) in 22 patients. Patients with moderate and severe clinical heart failure had similar degree of left ventricular myocardium impairment however those with severe symptoms had more pronounced right ventricular (RV) dysfunction (greater suppression of global and local RV contractility, greater percentage of irreversibly dysfunctional RV myocardium, lower RV contractile response to dobutamine infusion, more pronounced disturbances of RV diastolic filling). Dependence of RV pump function on pulmonary artery pressure was more evident in patients with severe clinical heart failure and marked dysfunction of RV myocardium than in patients with moderate symptoms and moderate RV myocardial dysfunction.

[Acute coronary syndrome and cell technologies].

The authors researched into the possibility of autologous bone marrow stem cell (MSC) application in patients with acute myocardial infarction (AMI). 10 patients with AMI received cell therapy after giving an informed consent. ECG and EchoCG revealed myocardial infarction (MI) in the basin of the anterior interventricular branch (AIB) of the left coronary artery (LCA) in 4 patients, in the basin of the circumflex branch (CB) of the LCA--in 3 patients, and in the basin of the right coronary artery (RCA)--in 3 patients. Patients older than 70, patients with acute heart failure and those who developed AMI more than 48 hours ago, were excluded from the study. All the patients were male, aged 56.3 +/- 5.2 years, mean time from pain onset to the performance of myocardial revascularization was 11.4 +/- 7.2 hours. Marrow mononuclear fraction was introduced into the infarction-related artery on the 5th-7th day after primary angioplasty and stenting. Marrow sampling and cell material introduction did not cause any complications. All the patients were re-studied 1 month after the MSC transplantation. All the patients' condition improved; no complications or side effects of the interventions were observed. Left ventricle ejection fraction increased from 42.9% to 51.4%; the average number of asynergic segments was 5.3 +/- 0.7 before the intervention and decreased to 2.6 +/- 0.7 (p < 0.01) afterwards. Systolic velocity before the intervention was 2.5 cm/sec, and after the procedure it increased to 4.6 cm/sec in the segments submitted to isolated revascularization and to 6.1 cm/sec--in segments where the intervention was accompanied by the introduction of MSC (p < 0.01). Contrast EchoCG demonstrated an increase of myocardial perfusion in the area of cell therapy. The chief results of the study are as follows: 1) autologous MSC transplantation in patients with acute coronary syndrome is a safe and well-tolerated procedure; 2) myocardial revascularization in combination with MSC introduction in AMI area improves total and local contractile myocardial function and normalizes diastolic filling process in the LV; 3) cell therapy improves the myocardial perfusion.

[Short- and long-term effects of internal carotid arteries stenting in high-risk patients].

The efficacy of endovascular treatment of internal carotid arteries (ICA) stenosis (20 patients) has been compared to that of conventional carotid endarterectomy (25 control cases). ICA stenting was performed in case of stenosis, narrowing arteries to > or = 60% in "symptomatic" patients and to > or = 80% in "asymptomatic" ones. Angiographic indices revealed favorable outcome after stenting in 100%. Mean extent of residual stenosis was 8.3 +/- 0.8%. Significant complications (stroke/fatal outcome) after 22 procedures developed in 3 (13.6%) cases. Mortality was estimated as 4.5%. Taking stroke and fatal cases into account, the interventions were successful in 86.4% cases. The duration of follow-up study was from 1 to 48 months, with 1 case resulting in death and 2--in development of acute disturbance of cerebral blood circulation of contralateral ICA. Short- and long-term results of the intervention did not significantly differ between the study and control groups thus indicating ICA stenting as an alternative to carotid endarterectomy procedure.

[Use of cognitive evoked potentials P300 in diagnosis of affection of the higher mental functions after surgery on the heart in conditions of cardiopulmonary bypass].

Parameters of cognitive evoked potentials P300 were studied in 40 patients with ischemic heart disease subjected to coronary artery bypass graft surgery in conditions of cardiopulmonary bypass before and 7-9 days after operation. Patients underwent also neurological and neuropsychological examination. The most significant P300 parameters proved to be P3 and N2 latency, an increase of which correlated with the level of developing cognitive deficiency. A neuroprotective effect of Tracilol during the surgery was confirmed. In patients receiving this drug, cognitive deficiency and changes of P300 parameters were less pronounced. A study of cognitive evoked potentials P300 may be recommended for detecting early cognitive dysfunction and estimation of neuroprotective therapy in patients operated on in conditions of cardiopulmonary bypass.

[Influence of cardiopulmonary bypass on cognitive functions in patients with ischemic heart disease].

Forty patients with ischemic heart disease subjected to coronary artery bypass graft surgery (CABGS) have been studied in conditions of cardiopulmonary bypass. All the patients underwent neuropsychological testing and enzyme immunoassay of chemokines (IL-8, IP-10, MCP-1, MCP-3, MIP-1, SDF-1alpha) and cytokines (TNF-alpha and IL-10). The study aimed at evaluation of the presence and severity of cognitive deficit developing after the surgery in conditions of cardiopulmonary bypass as well as of intrasurgery effect of tracilol on its expression. On day 9 after CABGS, there was an impairment of attention, audio-speech and memory and dynamic praxis. Tracilol exerted a pronounced neuroprotective action by inhibiting systemic inflammation response. Patients on intrasurgery treatment with tracilol did not demonstrate clinically significant cognitive deficit in the early postoperative period.

[Arterial and venous blood flow at different stages of vascular cognitive impairment].

Sixty-nine patients with vascular cognitive impairment (VCI) have been studied using complex assessment of clinical, cognitive, imaging and sonographic characteristics at different stages of the disease. The ratio of venous return from the brain to arterial inflow, an integral parameter of cerebral hemodynamics, has been also investigated. The results revealed that the most severe clinical, cognitive and imaging changes were typical for cases with disturbances of both arterial and venous cerebral blood flow. VCI progression was followed by the deterioration of cognitive and imaging characteristics. The advanced stage of VCI was featured by the most significant clinical, cognitive and imaging changes, on one hand, and moderate sonographic characteristics, on the other. Disorders of both arterial and venous cerebral blood flow components contribute to VCI pathogenesis.